Background And Objectives: Though universally employed, clinical signs to evaluate anesthetic adequacy are not reliable. Over the past years several pieces of equipment have been devised to improve intraoperative handling of anesthetic drugs, some of them directly measuring cerebral cortical activity (hypnosis). None of them, however, has offered the possibility of directly evaluating sub-cortical activity (motor response).
Contents: Spectral entropy measures irregularity, complexity or amount of EEG disorders and has been proposed as indicator of anesthetic depth. Signal is collected from the fronto-temporal region and processed according to Shannon's equation (H = - Sp k log p k, where p k represents the probability of a discrete k event), resulting in two types of analyses: 1) state entropy (SE), which evaluates cerebral cortex electrical activity (0.8 - 32Hz) and 2) response entropy (RE), containing both subcortical electromyographic and cortical electroence- phalographic components and analyzes frequencies in the range 0.8 - 47Hz.
Conclusions: Frontal muscles activation may indicate inadequacy of the subcortical component (nociception). Such activation appears as a gap between SE and RE. This, it is possible to directly evaluate both cortical (SE) and subcortical (RE) components providing better anesthetic adequacy.
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Crit Care Explor
January 2025
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
Importance: The current definition of central line-associated bloodstream infection (CLABSI) may overestimate the true incidence of CLABSI as it is often unclear whether the bloodstream infection (BSI) is secondary to the central line or due to another infectious source.
Objectives: We aimed to assess the prevalence and outcomes of central CLABSI at our institution, to identify opportunities for improvement, appropriately direct efforts for infection reduction, and identify gaps in the CLABSI definition and its application as a quality measure.
Design Setting And Participants: Retrospective cross-sectional study of patients identified to have a CLABSI in the period 2018-2022 cared for at the value-based purchasing (VBP) units of a 1200-bed tertiary care hospital located in Cleveland, OH.
J Psychiatr Res
January 2025
Department of Medicine, Universitat Internacional de Catalunya, Barcelona. c/ Dr. Josep Trueta s/n, Sant Cugat del Vallès, 08195, Barcelona, Spain. Electronic address:
Background: Determining anesthetic depth has been used to assess the optimal timing of electrical stimulus application in electroconvulsive therapy (ECT). This has improved the quality and effectiveness of seizures, as some anesthetics used can decrease efficacy. This study evaluated the influence of the Patient State Index (PSi) on the course of ECT in patients with major depressive disorder (MDD).
View Article and Find Full Text PDFJ Clin Med
December 2024
Collegium Medicum, WSB University, 41-300 Dabrowa Gornicza, Poland.
Eversion carotid endarterectomy (CEA) in awake patients is performed using cervical plexus blocks (CPBs) with or without carotid artery sheath infiltration (CASI) under ultrasound guidance. Although adequacy of anesthesia (AoA) guidance monitors nociception/antinociception balance, its impact on intraoperative analgesia quality and perioperative outcomes in awake CEA remains unexplored. Existing literature lacks evidence on whether AoA-guided anesthesia enhances clinical outcomes over standard techniques.
View Article and Find Full Text PDFDrug Alcohol Depend
February 2025
British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada; Interdepartmental Division of Addiction Medicine, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6.
Background: People exposed to fentanyl may report that the dose of methadone in the commonly accepted therapeutic range feels too low. We examined self-reported methadone dose adequacy.
Methods: We conducted a retrospective cohort study of individuals prescribed methadone at a dose of at least 60mg daily using data from three community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada from December 2016 through March 2020.
J Opioid Manag
January 2025
Western University of Health Sciences, Lebanon, Oregon.
Objective: The present opioid crisis has raised concern regarding the prescribing practices of physicians. However, the training of resident physicians has not been sufficiently evaluated. The proposed objective of this study was to evaluate how residents across different specialties perceived the adequacy of their training in the prescribing of opioid-based anal-gesics.
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